tbuckley/cabot-search huggingface dataset:
Abstract P355: Examining Sexual Identity Differences in Self-Measured Blood Pressure Monitoring Among Adults in the Behavioral Risk Factor Surveillance System
Authors: Danny Doan, Anisha Bhargava, Yashika Sharma, Billy A Caceres
Journal: Circulation (2023)

Background: Hypertension is a leading risk factor for cardiovascular disease. Self-measured blood pressure (SMBP) monitoring has been identified as an effective strategy to achieve BP control among adults with hypertension. Although there is growing evidence that sexual minority (e.g., gay/lesbian, bisexual) adults are at higher risk of hypertension than heterosexual adults, there is no data on hypertension self-management among sexual minority people with hypertension. Methods: We used data from the 2019 Behavioral Risk Factor Surveillance System to examine differences in SMBP monitoring between sexual minority and heterosexual participants with hypertension. Participants were asked questions regarding SMBP monitoring at home, including whether they were advised by a healthcare professional to check their BP at home, regularly checked their BP at home, and if they shared their home BP readings with a healthcare professional. We ran sex-stratified logistic regression models, adjusted for demographic factors and healthcare utilization, to estimate differences in SMBP monitoring between sexual minority and heterosexual participants. Results: The sample included 25,461 participants with a mean age of 54.1 ( ± 16.8) of which 95.1% were heterosexual, 1.7% were gay/lesbian, and 2.2% were bisexual. Although there were no differences in the odds of being advised by a healthcare professional to check their BP at home, lesbian women were more likely than heterosexual women to report taking their BP at home (AOR 1.23, 95% CI = 1.03-4.85) and sharing their home BP readings with a healthcare professional (AOR 2.31, 95% CI = 1.04-5.17). In contrast, bisexual women were less likely than heterosexual women to report taking their BP at home (AOR 0.59, 95% CI = 0.43-0.81) and sharing their home BP readings with a healthcare professional (AOR 0.56, 95% CI = 0.40-0.78). No differences in SMBP monitoring were found between sexual minority and heterosexual men. Conclusions: As the first examination of sexual identity differences in SMBP monitoring among adults with hypertension, this study addresses important knowledge gaps within cardiovascular and sexual minority health research. Lesbian women with hypertension exhibited more favorable self-management behaviors compared to heterosexual women. However, bisexual women with hypertension were less likely than heterosexual women to engage in SMBP monitoring. Findings suggest there is a need for clinical interventions to improve hypertension self-management among bisexual women.
Abstract P367: Automated Outreach to Improve Statin Initiation and Follow-Up of Lipid Panels Among Patients With High LDL-C
Authors: Matthew T Mefford, Hui Zhou, Mengnan Zhou, Hananeh Derakhshan, Teresa N Harrison, Mara Rojas, Michael H Kanter, Ronald D Scott, Tracy Imley, Mark Sanders, Royann Timmins, Kristi Reynolds
Journal: Circulation (2023)

Background: Despite their effectiveness in reducing low-density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) risk, high-intensity statins are underutilized among patients with LDL-C ≥ 190 mg/dL. We aimed to determine if a patient outreach program (KP Sure Net) automating high-intensity statin orders and lipid panels improved statin initiation and lab completions. Methods: Kaiser Permanente Southern California adults 20-60 years of age with LDL-C ≥ 190 mg/dL and no recent statin use were compared pre- (January 2016-September 2018, n=3,534) and post- (April 2019-July 2021, n=3,555) program implementation to examine statin prescriptions and fills, lab completions, and improved LDL-C (&lt;190 mg/dL) at 6 months. Using Poisson regression with robust variance, we calculated relative risks (RR) and 95% confidence intervals (CI) for the association of program implementation with statin prescriptions, fills, lab completions, and improved LDL-C, separately, adjusting for sociodemographics, insurance, comorbidity burden, and non-statin medication use. Results: Among adults identified during pre- and post-implementation, 759 (21.5%) and 976 (27.5%), respectively, received a statin prescription. Adults with a prescription post- versus pre-implementation were more likely to be younger, identify as Black or Asian ethnicity, be English-speaking and have higher income, but were similar by sex, education, insurance, and comorbidity burden. (Table) After multivariable adjustment, adults post- versus pre-implementation had a higher likelihood of receiving a statin prescription (RR 1.36, 95% CI 1.25, 1.48), filling their statin (RR 1.32, 95% CI 1.26, 1.38), completing their lipid panel (RR 1.60, 95% CI 1.44, 1.78), and improving LDL-C (RR 1.36, 95% CI 1.20, 1.53). Conclusion: Automating statin orders and lipid panels for high-risk adults improved prescription rates, fills and LDL-C. Understanding facilitators and barriers to adherence is an important next step in improving patients’ health.
Abstract P475: Left Ventricular Hypertrophy Prevalence by Electrocardiogram in Patients Presenting With Cerebrovascular Accident
Authors: Alexis Parks, Douglas Williams, Mariam Riad, Nupur Shah, Nikky Bardia, Christopher Malozzi, Bassam A Omar
Journal: Circulation (2023)

Background: A strong association has been previously suggested between left ventricular hypertrophy (LVH) and stroke. The prevalence of LVH and hypertension, however, differs depending on demographic variables. In light of the most recent hypertension guidelines, more aggressive blood pressure control is called for to achieve the lower goals set forth. This will hopefully translate into lower incidence of LVH and stroke. Objectives: To examine the prevalence of left ventricular hypertrophy in patients receiving an electrocardiogram (EKG) for a diagnosis of stroke, transient ischemic attack, or cerebrovascular accident; all of which will be referred to as CVA. Methods: An EKG database from a university cardiology noninvasive lab was examined for the diagnosis of CVA over a one year period. The EKGs were evaluated for the presence of LVH or atrial fibrillation/flutter. The results were analyzed using Chi square test. Results: There was a total of 14,798 EKGs performed over one year. There were 272 EKGs with a diagnosis of CVA (1.7%); 2364 EKGs (16%) with diagnosis of LVH, and 481 (3.2%) with diagnosis of atrial fibrillation/flutter. Out of the 272 EKGs in patients with CVA diagnosis, there were 174 EKGs in sinus rhythm without LVH (64%), 78 EKGs in sinus rhythm with LVH (29%, P &lt; 0.05), and 20 EKGs in atrial fibrillation or atrial flutter (7.4%, P &lt; 0.05). Discussion: Stroke is a major health problem associated with increased mortality and morbidity. While atrial fibrillation and atrial flutter are well-established causes of stroke and were nearly twice as frequent in CVA patients as the general population in our cohort, LVH by EKG, in the absence of atrial fibrillation/flutter, was also nearly twice as prevalent, underscoring its importance as a potential marker for CVA. Hypertension is a well established risk factor for stroke in addition to cardiovascular events, and is a major cause of LVH on EKG. In our cohort nearly one third of patients with stroke were in sinus rhythm, but had left ventricular hypertrophy by EKG, a prevalence that was nearly four times that of atrial fibrillation/flutter. Since hypertension is the most common cause of left ventricular hypertrophy in our population, this places further significance on hypertension as a major modifiable risk factor and predictor of CVA and cardiovascular disease in general. In light of the most recent hypertension guidelines, aggressive blood pressure management to achieve the newly defined lower limits for a diagnosis of hypertension, with monitoring for signs of left ventricular hypertrophy by EKG, should be emphasized in order to decrease the incidence of stroke and other cardiovascular events.
Abstract P375: Envisioning an “Ideal State” for Hypertrophic Cardiomyopathy — Patients and Health Care Professionals Discuss Steps to Improve Guideline-Directed Diagnosis and Treatment
Authors: Nicole Gonzalez, Kylie Picou
Journal: Circulation (2023)

Introduction: Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease, affecting an estimated 1 in 500 adults in the U.S. Despite its prevalence, the condition is underdiagnosed because HCM symptoms are not widely recognized among patients and health care professionals. Previously, the American Heart Association (AHA) hosted two Roundtable Discussions on HCM. These discussions identified diagnosis challenges and education resource gaps, and highlighted updates to HCM scientific guidelines. Objective: Build on previous Roundtables to identify steps needed to achieve an “ideal state” for patients with HCM through a guided discussion with patients and multi-disciplinary health care professionals. Methods: The virtual Roundtable was facilitated using a semi-structured interview guide with HCM patients (n=3) and multi-disciplinary health care professionals (n=8). The discussion recording was transcribed, and inductive and deductive thematic analyses identified key themes. Results: Patients described an “ideal state” that included increased awareness and management of HCM among patients and health care professionals, a greater sense of empowerment and trust in health care systems, and improved connections with allied health, mental health, and peer support services. Health care professionals described an “ideal state” as increased awareness of and training in HCM and genetics at all levels of medical education, equitable and timely access to care and diagnosis, improved models of care, and scientific advancements to improve treatment and diagnosis. Health care professionals cited financial barriers to achieving this state, particularly the need to improve health care financing to facilitate HCM care coordination across departments and health systems. The role of technology and digital tools was also identified as key to achieving the “ideal state,” with health care professionals noting both promise and limitations in their ability to improve HCM diagnosis and treatment. Conclusions: Reaching an “ideal state” for diagnosing and treating HCM patients requires systematic changes at the patient, health care professional, and health care system levels. Addressing the steps outlined during this discussion could vastly improve treatment, outcomes, and quality of life for patients with HCM as well as support health care professionals as they provide timely, guideline-directed diagnosis and treatment.
Abstract P263: Associations Between Dimensions of the Social Environment and Cardiometabolic Risk Factors
Authors: Joreintje D Mackenbach, Taymara C Abreu, Fleur Heuvelman, Linda J Schoonmade, Joline W Beulens
Journal: Circulation (2023)

Introduction: Although the social environment, including social contacts, norms and support, likely has a significant impact on cardiometabolic disease (CMD) risk, a comprehensive summary of the available evidence is lacking. Hypothesis: Exposure to unfavorable social environments is associated with greater CMD risk. Methods: We conducted a systematic review and meta-analysis on the association between social environmental characteristics and risk factors of CMD. We systematically searched PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., lipids, HbA1c or blood pressure as outcome and social environmental factors such as area-level deprivation, neighborhood racial segregation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO (CRD42021223035). Data were synthesized through vote counting and random effects meta-analyses, the latter if three or more associations investigated the same exposure-outcome combination. Results: A total of 168 studies reporting on 1050 associations were included in this review. Social and Economic Disadvantage was the most studied exposure (45%), followed by Social Relationships and Norms (35%), with less evidence for other social environmental dimensions. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher CVD risk scores (OR=1.54, 95%CI: 1.35;1.84). Meta-analyzed sex-specific associations showed inconsistent results. Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk. Conclusion: Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.
Abstract P265: Do Social Determinants of Health for Children’s Cardiometabolic Health Differ by Family Structure Type?
Authors: Minkyoung Song, Carol C Musil, Laura L Hayman
Journal: Circulation (2023)

Introduction: Social determinants of health (SDoH) impact cardiometabolic health, and certain SDoH that critically influence cardiometabolic health, such as adverse childhood experiences (ACEs), differ by family structure type. In particular, children living in grandparent-headed households experience a higher number of ACEs, on average, than children living in parent-headed households. Yet, there is limited understanding of whether/how SDoH might impact cardiometabolic health risk in children by family structure type. Purpose: We assessed selected SDoH factors known to influence children’s cardiometabolic health risk, stratified by family structure type (two-parent, single-parent, and grandparent-headed households). Methods: Utilizing data from the 2019-2020 National Survey of Children’s Health, we evaluated 9 SDoH (race/ethnicity, ACEs, health insurance status, received medical care for health conditions, received preventive check-ups, received food/cash assistance, food insufficiency, school engagement, and living in a safe neighborhood). All these factors were compared by family structure type by using a second-order Rao and Scott X 2 tests. Results: Among children aged 6-17 years (n=48,901), we found all 9 SDoH significantly differed by family structure type at p&lt;0.05. Results for each SDoH were as follows, with proportions shown for two-parent, single-parent, and grandparent-headed households, respectively, for each SDoH. Racial/ethnic minorities: 44%, 63%, and 59%; children experiencing ≥ 2 ACEs: 13.3%, 44.2%, and 54.1%; proportion uninsured: 6.3%, 8.3%, and 8.5%; proportion received medical care during past 12 months: 84.1%, 78.3%, and 78.4%; proportion received preventive check-ups during past 12 months; 80.1%, 72.5%, and 74.3%; proportion with food insufficiency: 26.2%, 45.1%, and 38.4%; proportion receiving food/cash assistance: 32.2%, 61.2%, and 73.1%; proportion with children “engaged in school”: 85.8%, 77.3%, and 79.4%; proportion living in unsafe neighborhoods: 4.3%, 8.8%, and 5.4%. Conclusions: Our findings show children living in grandparent-headed and single-headed households are more adversely affected by these cardiometabolic health-related SDoH than those living in two-parent households, and thus may be populations at particularly high risk for poor cardiometabolic health. Further investigations are needed to help identify modifiable factors that may influence the associations among family structure type, SDoH, and cardiometabolic health risk in children.
Abstract P360: Social and Psychosocial Determinants of Racial and Ethnic Differences in Cardiovascular Health: The MESA and MASALA Studies
Authors: Nilay S Shah, Xiaoning Huang, Lucia Petito, Michael Bancks, Alka M Kanaya, Sameera Talegawkar, Saaniya Farhan, Mercedes R Carnethon, Donald Lloyd-Jones, Norrina B Allen, Namratha Kandula, Sadiya S Khan
Journal: Circulation (2023)

Background: Social and psychosocial factors are associated with cardiovascular health (CVH) and may underlie race/ethnic differences in CVH. Quantifying the contribution of individual-level social and psychosocial factors to racial and ethnic differences in CVH may guide strategies to reduce disparities. Methods: In the MESA and MASALA cohorts, Kitagawa-Blinder-Oaxaca decomposition quantified the contributions of social and psychosocial factors to differences in mean CVH score (range 0-14, with 14 indicating optimal CVH) in Black, Chinese, Hispanic, or South Asian compared with White participants. Results: Among 7,978 adults (mean age 61 [SE 10] years, 52% female), there were 1,892 Black (mean CVH score 7.96), 804 Chinese (CVH 9.69), 1,496 Hispanic (CVH 8.00), 1,164 South Asian (CVH 9.16), and 2,622 White (CVH 8.91) participants. The factors that statistically contributed the most to explained differences in mean CVH score were income for Black participants (if mean income in Black participants were equivalent to White participants, Black participants’ mean CVH score would be 0.14 points higher, p&lt;0.05); place of birth for Chinese participants (if proportion of US-born and foreign-born individuals among Chinese adults were equivalent to White participants, Chinese participants’ mean CVH score would be 0.22 points lower, p&lt;0.05); and education for Hispanic and South Asian participants (if educational attainment were equivalent to White participants, Hispanic and South Asian participants’ mean CVH score would be 0.55 points higher and 0.37 points lower, respectively, p&lt;0.05 for both). Conclusions: In this multiethnic US cohort, social and psychosocial factors statistically explained racial and ethnic differences in CVH. Socioeconomic and immigration-related factors contributed the largest magnitude to CVH differences between race and ethnic groups.
Abstract P372: Drivers of Visit Modality in Primary Care Clinics at an Academic Medical Center
Authors: Vijaya Parameswaran, Harrison Koos, Rika Bajra, Elise C Torres, Neil M Kalwani, Lubna Qureshi, Leah Rosengaus, David Scheinker, Phillip Cola, Rajesh Dash, Kurt Stange, Kalle Lyytinen, Christopher Sharp
Journal: Circulation (2023)

Background: Informed by drivers of visit modality in specialty clinics, we sought to identify factors associated with visit modality selection (telemedicine vs. in-person) for new and return visits in primary care clinics at a large academic medical center (AMC). Methods: We used electronic health record data from 3/2020 - 5/2022 from 13 primary care clinics with 98 unique clinicians for new and 131 for return visits (21,031 new &amp; 207,292 return visits), with about 55% telemedicine (telephone and video) use. We used hierarchical logistic regression and cross-validation methods to estimate the variation in visit modality associated with the patient, clinician, and visit factors (measured with Area Under the Curve). Results: For both new and return visits, there was significant variation in telemedicine use among clinicians (ranging from 0 - 100%) for specific clinical diagnoses (Figure 1). Most variation in telemedicine use was attributed to the clinician seen (new visits) and primary visit diagnosis (return visits). Other visit and patient characteristics were less predictive. For new visits, the clinician model had an AUC of 0.79, followed by clinic site 0.69, whereas for return visits, the primary diagnosis was 0.77, followed by the clinician seen at 0.65. Diagnoses most commonly seen via telemedicine include acute respiratory infection and suspected COVID-19 exposure. Diagnoses commonly seen in-person include annual physical and gynecological exams. Conclusions: Our findings show high variability in telemedicine use for the same diagnosis and differential drivers of visit modality between new and return visits in primary care clinics at a large AMC. Provider ID was the most predictive factor of visit modality for new patients, indicating that clinician preference and individual practice patterns influence the modality of care much more than patient preference. Primary care clinics may reduce the variability in visit modality through standardized processes that integrate clinical factors and patient preference.
Abstract P467: Left Atrial Appendage Occlusion and Risk of Stroke in Medicare Beneficiaries
Authors: Wendy Wang, Lin Y Chen, Rob F Walker, Alvaro Alonso, Faye L Norby, Kamakshi Lakshminarayan, Pamela L Lutsey
Journal: Circulation (2023)

Background: Atrial fibrillation (AF) is a significant risk factor for stroke, with oral anticoagulants (OACs) recommended for stroke prevention. However, a nonpharmacologic option is needed for patients with contraindications for OACs. Recently, percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative treatment option. Although clinical trials have shown that percutaneous LAAO is non-inferior to warfarin and direct OACs, few studies using real-world data have been done. Methods: Using data from the Medicare 20% sample databases (2015-18), we assessed the association between percutaneous LAAO vs. OAC use and risk of all stroke among patients with AF who had an elevated CHA 2 DS 2 -VASc score. Secondary outcomes included death and hospitalized bleeding. Patients undergoing percutaneous LAAO were matched with up to 5 other patients who were taking OACs by sex, age, date of enrollment, index date, and CHA 2 DS 2 -VASc score. A total of 17,514 patients with AF were matched (average [SD] 78 [6] years, 44% female). Cox proportional hazards model was used. Results: Over a median follow-up of 10.3 months, 293 stroke events, 1,925 deaths and 618 major bleeding events occurred. After multivariable adjustments, no significant difference for risk of stroke or death was noted when patients with percutaneous LAAO was compared to those taking OACs (HRs [95% CIs]: 1.25 [0.95, 1.67] and 0.94 [0.83, 1.06], respectively). However, there was a 3.24-fold (95% CI: 2.75, 3.81) increased risk for hospitalized bleeding after percutaneous LAAO compared to OAC. Conclusion: Using data from the Medicare 20% sample databases, no significant difference in risk of stroke or death were noted when percutaneous LAAO was compared to OAC users. However, there was an increased risk for bleeding. Our results confirm the results of randomized trials that among older patients with AF and a high-risk for stroke, percutaneous LAAO may be an alternative to OAC use; however, patients should be aware of potential risks associated with the implantation.